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General NPI Number Information
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NPI Number | 1205512555
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Entity Type | Individual
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Provider Name | THERESE ANN HARDISON LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 7750 CLAYTON RD STE 303
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1341
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Country | US
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Telephone | 314-649-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 5109 LAKEWOOD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63123-3719
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Country | US
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Telephone | 708-921-1151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2023024663
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License Number State | MO
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